College Students Undertreated for Psychiatric Conditions

by John Gever John Gever,Senior Editor, MedPage Today
December 01, 2008

Action Points

Explain to interested patients that the study found that psychiatric conditions were no less common in college students than other young people.

Explain that the study found most college students with mental illnesses did not receive treatment. For alcoholism and substance abuse disorders, treatment rates for college students were lower than for others in the same age group.

NEW YORK, Dec. 1 -- Although mental health problems are common among college students, they are less likely to seek treatment for them than are others in the same age group, researchers here said.

Both groups of young people have similar overall rates of psychiatric disorders, but students were significantly less likely to seek treatment for drug and alcohol problems, reported Mark Olfson, M.D., M.P.H., of Columbia University, and colleagues in the Dec. 1 issue of the Archives of General Psychiatry.

Among more than 5,000 people 19 to 25 years old who participated in a large national interview-based survey, 45.8% (95% CI 43.0% to 48.6%) of those enrolled as students and 47.7% (95% CI 44.7% to 50.8%) of non-students in this age group had a psychiatric disorder in the previous year, according to objective DSM-IV criteria.

Among those with such disorders, only 18.5% (95% CI 15.5% to 21.8%) of students and 21.5% (95% CI 18.5% to 24.9%) of others in the age group had sought treatment for them.

The two groups differed significantly when it came to treatment of alcoholism and substance use disorders.

The researchers found that college students were only half as likely to seek treatment for these conditions, compared to their non-student peers (adjusted OR 0.49, 95% CI 0.28 to 0.87).

Barely 5% of students with alcohol or drug problems sought treatment, compared with about 10% of non-students.

"The prevalence of psychiatric disorders is high in this population at a particularly vulnerable time of development," wrote Dr. Olfson and colleagues.

"As these young people represent our nation's future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non-college-attending peers."

The findings emerged from the National Epidemiologic Study on Alcohol and Related Conditions, conducted in 2001 and 2002 with 43,093 people. Included in the sample were 2,188 college students and 2,904 others ages 19 to 25.

Structured interviews conducted as part of the survey were detailed enough to allow diagnoses of psychiatric conditions by DSM-IV criteria.

The survey constitutes the largest nationally representative survey of psychiatric disorders in college students and their non-college-attending peers, Dr. Olfson and colleagues said.

Although the overall rates of disorders did not differ significantly between groups, rates for individual categories of mental illness did show distinct patterns.

Compared with non-students, those enrolled in college were less likely to be diagnosed with drug-related disorders, bipolar disorder, conduct disorder, and most subcategories of personality disorder.

College students were also less likely to use tobacco.

Except for alcohol- and drug-related disorders, treatment rates did not differ between students and non-students.

Treatment rates were highest for mood disorders, with 34.1% of students and 34.8% of non-students having sought therapy.

Anxiety disorders were treated at rates of 15.9% for students and 12.4% for non-students (difference not significant).

Dr. Olfson and colleagues said that major life stressors were relatively uncommon in the sample, compared with the general population.

When they did occur, however, they were associated with increased rates of psychiatric disorders.

"College-aged individuals may have less well-developed coping mechanisms or less experience than older adults with romantic disappointments and interpersonal losses, making them particularly vulnerable to the effects of these and related stressors," the researchers speculated.

They cited several limitations to the study. It did not attempt to diagnose ADHD or certain other neuropsychiatric conditions, nor did it evaluate participants' self-perceived need for treatment.

Moreover, the survey design may have missed caused participants to under-report some mental health treatments.

The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded in part by the Intermural Program, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. This study was supported by the National Institutes of Health, the American Foundation for Suicide Prevention, and the New York State Psychiatric Institute.

No potential conflicts of interest were reported.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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